2009-2010年中国内地甲型H1N1流感确诊病例流行特征分析

目的 分析中国内地甲型H1N1流感(甲流)确诊病例的流行病学特点,为更好地防控流感疫情提供借鉴。 方法 对上报疾病监测信息报告管理系统的甲流确诊、住院、死亡病例进行描述性流行病学分析,对甲流平均检测阳性率进行时间分布分析。 结果 截至2010年7月4日,我国内地累计报告确诊病例127 885例,其中住院(含死亡)31 651例,死亡805例。2009年5月10日,报告首例输入性甲流确诊病例,截至7月18日每周新增报告的境外输入性病例超过本地感染病例。截至8月30日每周报告病例数、报告病例的新增县(区)数、甲流检测阳性率均呈缓慢上升趋势,8月31日以后均迅速增加。Spearman相关性分析显示,确诊病例数与甲流检测阳性率趋势一致(P0.0001)。11月23-29日所在周报告的确诊、住院、死亡病例数均达到峰值。截至2010年1月底,累计确诊病例中6~15岁所占比例(43.5%)和发病率(2750/10万)均最高;学生占66.3%。各年龄组中,25岁年龄组住院率最高;5岁人群死亡率最高,其次为15~24岁。 结论 2009-2010年我国内地出现一个甲流流行高峰,流行分为4个阶段:传入期、低流行期、流行高峰期、流行后期。学龄儿童、青少年和年轻成年人甲型H1N1感染发病的风险最高,儿童、青少年和年轻成年人发生严重病情的风险也最高。     

Adriamycin, bleomycin, and CCNU as effective induction chemotherapeutic agents in advanced squamous cell carcinoma (COG Protocol 7333).

Twenty-six member institutions of the Central Oncology Group entered 154 patients in this two-armed, phase III study comparing the effects of adriamycin, bleomycin, and CCNU against a variety of squamous cell carcinomas. The combination of adriamycin and bleomycin produced a 43% overall response rate in primary tumors of the head and neck, which included two complete responses. This compares favorably to the results obtained with methotrexate and other agents previously reported. The combination of adriamycin and bleomycin will probably be the most useful for induction chemotherapy because both drugs have cumulative toxicities and the duration of response to this combination is short.     

The Delayed Effect of Sodium Valproate on the Photoconvulsive Response in Man

The acute effect of a single oral dose of sodium valproate on the photoconvulsive response has been studied. In 7 of 9 patients naive to this drug photosensitivity was abolished or reduced. A similar effect was seen in only 2 of 7 already receiving chronic sodium valproate therapy. The effect appeared 1 to 5 hr (mean, 3 hr) after attainment of peak sodium valproate concentration and lasted up to 5 days.     

Combined surgical and radiologic intervention for complicated cholelithiasis in high-risk patients

Ultrasound-guided surgical cholecystostomy with local infiltration anesthesia was combined with radiologic removal of gallstones in 36 elderly patients with acute calculous gallbladder disease who were considered to be at high risk due to multiple coexisting diseases. At cholecystostomy, the fundus of the gallbladder was sutured to the anterior abdominal wall resulting in a short surgical track to the gallbladder. This permitted early percutaneous stone removal through the cholecystostomy track under fluoroscopic guidance. All gallstones were removed in 31 of 36 patients, for an overall success rate of 86%. The success rate was 97% for gallbladder stones, 86% for cystic duct stones, and 63% for common bile duct stones that were removed by traversing the cystic duct. The treatment in the five patients in whom radiologic stone removal was incomplete or unsuccessful consisted of elective cholecystectomy in three, with common bile duct exploration in two of these; endoscopic sphincterotomy and stone extraction in one; and expectant management in one. There were no deaths or serious complications. This technique has thus proved safe and effective in these 36 high-risk patients.     

Phase I study of recombinant interleukin-1 beta in patients undergoing autologous bone marrow transplant for acute myelogenous leukemia

A phase I trial was conducted with recombinant human interleukin-1 beta (rhIL-1 beta) in patients undergoing autologous bone marrow (BM) transplantation for acute myelogenous leukemia. rhIL-1 beta was administered at 3 dose levels (0.01, 0.02, 0.05 microgram/kg) by 30 minute intravenous infusion once a day beginning on the day of BM infusion and continuing for a total of 5 doses. A total of 17 patients were entered on the trial, and their results were compared with those of 74 consecutive historical control patients that did not receive colony stimulating factors. Moderate toxicity was observed in all patients. All 17 patients developed fever and chills within 30 minutes after initiation of rhIL-1 beta, and hypotension was observed in 14 of 17 patients 5 to 8 hours after the infusion. A total of 30% of patients required therapy (normal saline or dopamine) for treatment of hypotension. Therefore, dose escalation was discontinued at the 0.05 microgram/kg dose level. The number of days required to achieve an absolute neutrophil count greater than 500 mL in patients who received rhIL-1 beta was less than in historical patients (25 v 34; P = .02). This appeared to correlate with a reduced incidence of infection between days 0 and 28 after BM infusion (12% v 23%; P = .049). Median bilirubin, median creatinine, platelet recovery, and days in the hospital were not different between study patients and historical controls. Survival of patients who received rhIL-1 beta compared with that of historical patients was improved (30% v 20%; P = .04). These possible benefits were achieved at the cost of moderate toxicity during rhIL-1 beta administration.